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How to maximize graft survival
1Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Purpose Of Review:
Kidney transplant failure results in significant patient morbidity and mortality, increased financial burden and exacerbates the organ shortage faced by kidney transplant candidates. The different strategies to maximize graft survival in kidney transplant recipients is presented in this review.
Recent Findings:
Maximizing kidney graft survival requires optimizing immunosuppression, preventing and managing recurrent disease and using general chronic kidney disease strategies to slow allograft injury. Herein, we review: 1) strategies to tailor immunosuppression to the individual patient to avoid over and underimmunosuppression, and avoid immunosuppression-related drug toxicities, 2) latest findings in the following recurrent diseases: focal segmental glomerulosclerosis, membranous nephropathy, complement-mediated kidney disease and monoclonal gammopathy of renal significance, and, 3) approaches to slow allograft injury including BP control, and the use of antiproteinuric agents and SGLT-2 inhibitors.
Summary:
The last two decades has seen significant improvement in allograft outcomes resulting from advances in immunosuppression. With the federal government's renewed focus on kidney disease and transplantation, and recent advances in biomarkers, genetic testing, big data analytics and machine learning, we hope to see further outcome improvements in the next decade.
Insights
Maximizing kidney transplant graft survival involves optimizing immunosuppression and managing recurrent diseases. Strategies include personalized immunosuppression, addressing specific kidney diseases, and slowing allograft injury with blood pressure control and SGLT-2 inhibitors.
Area of Science:
- Nephrology
- Transplantation immunology
Background:
- Kidney transplant failure leads to poor patient outcomes, increased costs, and organ shortages.
- Optimizing graft survival is critical for recipients.
Approach:
- This review examines strategies to maximize kidney graft survival.
- Key areas include immunosuppression optimization, recurrent disease management, and chronic kidney disease strategies.
Key Points:
- Tailoring immunosuppression to individual patients prevents over/under-immunosuppression and drug toxicities.
- Recent findings cover focal segmental glomerulosclerosis, membranous nephropathy, complement-mediated kidney disease, and monoclonal gammopathy of renal significance.
- Approaches to slow allograft injury include blood pressure control, antiproteinuric agents, and SGLT-2 inhibitors.
Conclusions:
- Advances in immunosuppression have improved allograft outcomes over the past two decades.
- Future improvements are anticipated due to increased focus on kidney disease, biomarkers, genetic testing, and machine learning.
